1649652249 NPI number — OWENSBORO HEALTH MEDICAL GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649652249 NPI number — OWENSBORO HEALTH MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OWENSBORO HEALTH MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OWENSBORO HEALTH MEDICAL GROUP - FAMILY MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649652249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWENSBORO
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42304-3229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-691-8070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1871 US HIGHWAY 41A S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DIXON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42409-9448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-639-9440
Provider Business Practice Location Address Fax Number:
270-639-9446
Provider Enumeration Date:
06/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HACKBARTH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
270-417-4813

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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